Congress, staff to buy insurance in D.C. exchange

The Office of Personnel Management has finalized a rule for how members of Congress and aides will obtain health coverage through the exchanges starting in January — and it’s requiring members of Congress and staff to enroll in the District of Columbia small-business exchange, even if they live or work outside the D.C. metro area.

They won’t be eligible for subsidies to buy insurance regardless of their income, although they’ll be able to receive a federal employer contribution. But according to the rule, they’ll be able to collect that employer subsidy by buying in the small-business exchange, also known as SHOP.

Text Size

-

+

reset

“SHOPs are designed to provide employer-sponsored group health benefits and are, therefore, the appropriate environment in which to provide an employer contribution to members of Congress and congressional staff,” the rule says.

Committee staffers said that, on a Monday morning call with OPM, they were told that federal contributions can be applied only to the most comprehensive and expensive plans — known as gold plans. That requirement isn’t in the rule but could be included in additional guidance.

Members will also get a one-month extension — until Oct. 31 — to designate which aides will be considered “official office” staff and must go on the exchanges. Staffers who work for committees are allowed to remain on the Federal Employees Health Benefits program.

Federal retirees can also stay on the FEHB plans. Current staff will be eligible for FEHB coverage during retirement only if they have continuous coverage on the SHOP exchange while they are employed by Congress.

OPM received more than 59,000 comments about abortion coverage in the exchange plans. The rule says that no federal funds, including administrative funds, can be used to cover abortions or administer plans that cover abortions.

The D.C. exchange, DC Health Link, has said its SHOP exchange, which primarily exists for small businesses, will be fully operational on Tuesday. OPM plans to set up a specialized website to help members of Congress and designated staff enroll in the exchange, according to staff who were on the call with OPM Monday morning.